The Journal of Allergy and Clinical Immunology
Volume 119, Issue 1 , Pages 192-198 , January 2007

Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: A randomized, double-blind, placebo-controlled trial

  • Kaarina Kukkonen, MD

      Affiliations

    • From the Skin and Allergy Hospital, University of Helsinki
    • Corresponding Author InformationReprint requests: Kaarina Kukkonen, MD, Helsinki University Central Hospital, the Skin and Allergy Hospital, Meilahdentie 2, PO Box 160, 00029 HUCH Helsinki, Finland.
  • ,
  • Erkki Savilahti, MD, PhD

      Affiliations

    • Hospital for Children and Adolescents, University of Helsinki
  • ,
  • Tari Haahtela, MD, PhD

      Affiliations

    • From the Skin and Allergy Hospital, University of Helsinki
  • ,
  • Kaisu Juntunen-Backman, MD, PhD

      Affiliations

    • From the Skin and Allergy Hospital, University of Helsinki
  • ,
  • Riitta Korpela, PhD

      Affiliations

    • Institute of Biomedicine, Pharmacology, University of Helsinki
    • Valio Research and Development, Helsinki
  • ,
  • Tuija Poussa, MSc

      Affiliations

    • STAT-consulting, Tampere
  • ,
  • Tuula Tuure, PhD

      Affiliations

    • Valio Research and Development, Helsinki
  • ,
  • Mikael Kuitunen, MD, PhD

      Affiliations

    • From the Skin and Allergy Hospital, University of Helsinki

Received 9 June 2006 ,Revised 7 September 2006 ,Accepted 11 September 2006.

References 

  1. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299:1259–1260
  2. Sudo N, Sawamura S, Tanaka K, Aiba Y, Kubo C, Koga Y. The requirement of intestinal bacterial flora for the development of an IgE production system fully susceptible to oral tolerance induction. J Immunol. 1997;159:1739–1745
  3. Björkstén B, Sepp E, Julge K, Voor T, Mikelsaar M. Allergy development and the intestinal microflora during the first year of life. J Allergy Clin Immunol. 2001;108:516–520
  4. Noverr MC, Huffnagle GB. The “microflora hypothesis” of allergic diseases. Clin Exp Allergy. 2005;35:1511–1520
  5. Newburg DS. Oligosaccharides in human milk and bacterial colonization. J Pediatr Gastroenterol Nutr. 2000;30(suppl 2):S8–S17
  6. Gibson GR, Roberfroid MB. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr. 1995;125:1401–1412
  7. Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001;357:1076–1079
  8. Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol. 1997;99:179–185
  9. Viljanen M, Savilahti E, Haahtela T, Juntunen-Backman K, Korpela R, Poussa T, et al. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial. Allergy. 2005;60:494–500
  10. Rosenfeldt V, Benfeldt E, Nielsen SD, Michaelsen KF, Jeppesen DL, Valerius NH, et al. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol. 2003;111:389–395
  11. Weston S, Halbert A, Richmond P, Prescott SL. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child. 2005;90:892–897
  12. Bruijnzeel-Koomen C, Ortolani C, Aas K, Bindslev-Jensen C, Bjorksten B, Moneret-Vautrin D, et al. Adverse reactions to food. European Academy of Allergology and Clinical Immunology Subcommittee. Allergy. 1995;50:623–635
  13. Williams HC, Burney PG, Pembroke AC, Hay RJ. The U.K. Working Party's diagnostic criteria for atopic dermatitis. III. Independent hospital validation. Br J Dermatol. 1994;131:406–416
  14. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113:832–836
  15. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186:23–31
  16. National Asthma Education and Prevention Program . Expert Panel Report. Long-term management of asthma in children: effectiveness of inhaled corticosteroids compared to other medications. J Allergy Clin Immunol. 2002;110:S147–S160
  17. International Rhinitis Management Working Group . International Consensus Report on the diagnosis and management of rhinitis. Allergy. 1994;49:1–34
  18. The European Academy of Allergology and Clinical Immunology . Position paper: allergen standardization and skin tests. Allergy. 1993;48:48–82
  19. Hartemink R, Kok BJ, Weenk GH, Rombouts FM. Raffinose-bifidobacterium (RB) agar, a new selective medium for bifidobacteria. J Microbiol Methods. 1996;27:33–43
  20. Suomalainen TH, Mäyrä-Mäkinen AM. Propionic acid bacteria as protective cultures in fermented milks and breads. Lait. 1999;79:165–174
  21. Ly NP, Gold DR, Weiss ST, Celedon JC. Recurrent wheeze in early childhood and asthma among children at risk for atopy. Pediatrics. 2006;117:e1132–e1138
  22. Lanning D, Sethupathi P, Rhee KJ, Zhai SK, Knight KL. Intestinal microflora and diversification of the rabbit antibody repertoire. J Immunol. 2000;165:2012–2019
  23. Kelly D, Conway S, Aminov R. Commensal gut bacteria: mechanisms of immune modulation. Trends Immunol. 2005;26:326–333
  24. Christensen HR, Frokiaer H, Pestka JJ. Lactobacilli differentially modulate expression of cytokines and maturation surface markers in murine dendritic cells. J Immunol. 2002;168:171–178
  25. Viljanen M, Pohjavuori E, Haahtela T, Korpela R, Kuitunen M, Sarnesto A, et al. Induction of inflammation as a possible mechanism of probiotic effect in atopic eczema-dermatitis syndrome. J Allergy Clin Immunol. 2005;115:1254–1259
  26. Sistek D, Kelly R, Wickens K, Stanley T, Fitzharris P, Crane J. Is the effect of probiotics on atopic dermatitis confined to food sensitized children?. Clin Exp Allergy. 2006;36:629–633
  27. Kusel MM, Holt PG, de Klerk N, Sly PD. Support for 2 variants of eczema. J Allergy Clin Immunol. 2005;116:1067–1072
  28. Flohr C, Johansson SG, Wahlgren CF, Williams H. How atopic is atopic dermatitis?. J Allergy Clin Immunol. 2004;114:150–158
  29. Rönmark E, Perzanowski M, Platts-Mills T, Lundback B. Four-year incidence of allergic sensitization among schoolchildren in a community where allergy to cat and dog dominates sensitization: report from the Obstructive Lung Disease in Northern Sweden Study Group. J Allergy Clin Immunol. 2003;112:747–754
  30. Yazdanbakhsh M, Kremsner PG, van Ree R. Allergy, parasites, and the hygiene hypothesis. Science. 2002;296:490–494
  31. Wilson MS, Taylor MD, Balic A, Finney CA, Lamb JR, Maizels RM. Suppression of allergic airway inflammation by helminth-induced regulatory T cells. J Exp Med. 2005;202:1199–1212
  32. Veckman V, Miettinen M, Pirhonen J, Siren J, Matikainen S, Julkunen I. Streptococcus pyogenes and Lactobacillus rhamnosus differentially induce maturation and production of Th1-type cytokines and chemokines in human monocyte-derived dendritic cells. J Leukoc Biol. 2004;75:764–771
  33. Yoshimura A, Lien E, Ingalls RR, Tuomanen E, Dziarski R, Golenbock D. Cutting edge: recognition of Gram-positive bacterial cell wall components by the innate immune system occurs via Toll-like receptor 2. J Immunol. 1999;163:1–5
  34. Netea MG, Van der Meer JW, Kullberg BJ. Toll-like receptors as an escape mechanism from the host defense. Trends Microbiol. 2004;12:484–488
  35. Ling EM, Smith T, Nguyen XD, Pridgeon C, Dallman M, Arbery J, et al. Relation of CD4+CD25+ regulatory T-cell suppression of allergen-driven T-cell activation to atopic status and expression of allergic disease. Lancet. 2004;363:608–615

 Supported by the Helsinki University Central Hospital Research Funds and Valio Ltd, Helsinki, Finland. Part-time monthly salaries that M.K. received and monthly salaries that K.K. received from the Clinical Research Institute Helsinki University Central Hospital Ltd were funded by Valio Ltd.Disclosure of potential conflict of interest: K. Kukkonen has received grant support from Valio Ltd. R. Korpela and T. Tuure are employed by Valio Ltd and by R&D. T. Poussa has consultant arrangements with Valio Ltd. M. Kuitunen has received grant support from Valio Ltd. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(06)01908-7

doi: 10.1016/j.jaci.2006.09.009

The Journal of Allergy and Clinical Immunology
Volume 119, Issue 1 , Pages 192-198 , January 2007